My Top Three Reasons for Not Accepting Every Insurance Plan

Jun 30, 2016
4 min read

As a private practice owner, I decided not to be a participating provider with all insurance plans. I will explain my reasoning in this article.

I wrote an article back in 2014 considering the pros and cons of taking insurance versus not taking insurance related to vision therapy.

Fast forward one year and a half, and I found myself faced with the very same decision, but this time it was not just vision therapy related as I was opening up a brand new full scope practice cold.

If you talk to some older docs, they'll tell you traditionally it is best to get on as many insurance panels as possible when opening a brand new location to encourage as many people as you can through the door.

Unfortunately, it is 2016 and insurance and reimbursements are just not what they used to be.

I am going to list my top three reasons why my partner and I chose to only participate with only THREE major medical insurances (Medicare, Blue Cross Blue Shield, & Aetna) and only ONE vision plan (EyeMed - primarily for contact lens benefits).

1. Offering Specialty Care Services

My practice offers full scope optometric care, but our primary focus is on vision therapy and rehabilitation. For that reason, it made sense to limit the plans that we participated in because many insurances companies will not cover vision therapy services. We did not want patients to be confused by the fact that their routine exam was covered, but they would have to pay for therapy.

Here is a true story: a patient paid for therapy out of pocket because we did not participate with his insurance, but was told by three (THREE!) different people at his insurance that he would be reimbursed because he had out of network benefits and the service was covered. Well, lo and behold, he submitted his claim and it was denied because the "service was actually not covered and those three people he spoke to were mistaken." Yeah. Not a great story and many VT doctors will tell you stories of getting verbal approval over the phone just to start therapy and then later receive denial letters for the service.

Any specialty care service such as orthokeratology, scleral lens fittings or even some dry eye procedures are typically not covered by insurance. If you plan to set yourself apart in your community by offering these services, consider being selective about the insurances you take.

2. No Optical

As mentioned in a previous article, we decided to open our practice without an optical. 

Because of this, we were not eligible for certain panels because we did not offer spectacle services in house. Other panels were just not appealing with their low reimbursement rates.

3. Autonomy

I've worked in both retail and private practice (one took every insurance and another took very limited insurances) before opening my business.

My experience was in the practice settings that took almost all insurances, I was running from patient to patient, spending maybe 10-15 minutes with each one, oftentimes not getting a lunch and by the end of the day my head was spinning.

After all of that, the day's net profit was considerably out of proportion with the amount of work I had put in.

It felt like I was just working to be busy, but not to be profitable.  

Take this example:

Exam cost for a new private pay patient: $125

Exam reimbursement from X insurance: $40

In the same amount of time I would spend with the private pay patient, I would have to see THREE of those low reimbursing insurance patients to make the same amount of money.

Would you rather see more patients, but not make any more money? I think I know the answer.

Ultimately by taking the insurances that work for best for your office and eliminating the ones that are bogging things down, you will be able to spend a little more time with your patients, give them a higher level of care and receive an appropriate payment  for your service that is not always dictated by an insurance company.

Are you currently working in an office where you are on every insurance panel and seeing a lot of patients, but not really making the money you should?

If so, review which plans are costing you money or not worth the headache and start to drop them.

Is it scary? Will you lose patients?

Absolutely, but you will be a better doctor (and happier one) for making the necessary changes for your business!

Comment below with your experience with insurance, dropping insurance or any questions you may have!

About Miki Lyn D'Angelo, OD

Miki Lyn D’Angelo, O.D. graduated with honors from the SUNY College of Optometry in New York, receiving the VSP Excellence in Primary Care and Excellence in Vision Therapy awards. She then continued her education by completing a residency in vision therapy and rehabilitation with Dr. Barry Tannen, OD. She has extensive experience in family eye care with a specialty and passion for pediatrics, vision training and neuro-rehabilitation with traumatic brain injury patients. She recently just opened a private practice cold with a partner on the Eastern End of Long Island. In her spare time she loves cooking and working on the farm with her fiancé.